Parenteral Flashcards
Parenteral means administered in a manner other than _________________
Through the digestive tract
Name 3 circumstances in which parenteral routes are used
- vomiting - cannot swallow - restricted from taking oral fluids
When administering parenteral medication, what “cleaning” technique do you use?
aseptic
Name and describe the four routes for parenteral administration
- Intradermal (ID): into dermis just under epidermis 2. Subcutaneous: into tissues just under the dermis 3. Intramuscular (IM): into the body of a muscle 4. Intravenous (IV) injection or infusion: injection into a vein
Name five complications that can occur if you fail to inject a medication correctly
- inappropriate drug response (too rapid or too slow) - nerve injury with associated pain - localized bleeding - tissue necrosis - sterile abscess
What is the best site for IM injections? Why were nurses reluctant to use this site?
Ventrogluteal difficulty in anatomically locating it and belief it isn’t safe
What are the four Principles of preventing infection during an injection? What techniques should be used for each?
- Prevent contamination of solution (ampules closed, med removed quick)
- Prevent needle contamination (avoid touching contam. surface; avoid touching length of plunger, keep tip covered)
- Prepare skin (wash soiled with soap/water, friction and circular motion with antiseptic swap, swab from center of site and move outward in a 5-cm (2-inch) radius
- Reduce transfer of microorganisms (perform hand hygiene for a minimum of 15 seconds)
VENTROGLUTEAL
Advantages:
Preferred site for what kind of medications:
Pain compared to vastus lateralis:
Recommendations for children:
Advantages: deep and away from major nerves/blood vessels; easily identified by prominent bony landmarks
Preferred site for what kind of medications: large in volume, more viscous, irritating
Pain compared to vastus lateralis: less painful
Recommendations for children: pediatric IM injection site for children of all ages
VASTUS LATERALIS
Advantages:
Used for what in children:
Pediatric recommendations:
Advantages: absence of major nerves/blood vessels, drug absorption rapid
Used for what in children: immunizations
Pediatric recommendations: IM injection site for infants up to 12 months of age
DELTOID
Advantages:
Disadvantages:
What kind of meds used for:
May be used for what in adults:
Pediatric recommendations:
Advantages: easily accessible, faster absorption rate
Disadvantages: not well developed in most patients
What kind of meds used for: small volumes
May be used for what in adults: vaccination (depending on development of muscle)
Pediatric recommendations: IM injection site for children 18 months and older
Six Rights of Med Admin
- Right person
- Right time
- Right route
- Right dose
- Right drug
- Right documentation
10 Guidelines to follow to ensure safe med admin
- be vigilant (know your shit)
- expiry date
- 2 identifiers
- clarify/ask for help
- use technology-no workarounds
- strict aseptic technique during prep and admin
- educate patients during admin
- don’t delegate
- no-interruption zones
- minimize patient discomfort
What is a “workaround”? How and why do nurses use them?
A “workaround” bypasses a procedure, policy or problem in the system.
They fail to follow agency policies, protocols, or procedures in an attempt to admin meds faster
12 ways to minimize patient discomfort during injection
- use sharp, beveled needle in the shortest length/smallest guage
- change needle if liquid coats shaft
- position and flex pt’s limbs to reduce muscular tension
- divert pt’s attention
- apply vapocoolant spray or topical anesthetic or place wrapped ice for a minute before
- insert needle at proper angle, smoothly and quickly. don’t hesitate
- inject med slowly but smoothly
- hold syringe steady once needle is in tissue to prevent tissue damage
- withdraw the needle smoothly at same angle used for insetion
- gently apply antiseptic pad or dry sterile gauze pad to site
- apply gentle pressure at injection site
- rotate injection sites to prevent formation of indurations and abscesses
What is the most frequent route of exposure to bloodborne disease for health care workers? Where is this most likely to occur? When do they occur?
Needlestick injuries
In pt rooms and the OR
When HCWs recap needles, mishandle IV lines and needles, or leave needles at pt bedside
8 Recommendation for the Prevention of Needlestick injuries
- avoid needles when effective needleless systems or SESIP safety devices are available
- do not recap after admin
- plan safe handling and disposal before beginning
- immediate disposal in sharps container
- maintain sharp injury log
- attent educational offering and follow recommendations (incld. receiving hep B vaccine)
- report all needlestick injuries
- participate in selection and eval of SESIP devices
What is a SESIP? Name 2 types
Sharp with engineered sharps injury prevention (SESIP)
blunt-end cannula; safety syringe equipped with plastic guard or sheath that slips over needle as it is withdrawn from skin
What are 4 requirements for sharps containers?
- only one hand needs to be used
- stand upright
- not allowed to overfill
- be colored red or labeled with biohazard
When administering parenteral injections, you must first determine 43things:
These determinations are based on 3 things:
- appropriate size, length, and guage of needle; volume of solution; medication route
- quantity of med, type of med, body size of pt
What do electronic infusion pumps do?
ensure a constant and accurate delivery of medication
Syringe capacity ranges from ___mL - ___mL
0.5 mL - 60 mL
It is unusual to use a syringe larger than ___ mL for IM injections
5 mL
Why are large volumes of meds not good?
create pain and dicomfort for pt
Syringes are most commonly marked in a scale of ________
tenths of a million
What kind of syringes do you use to prepare small amounts of medication for ID and subQ injections?
tuberculin (TB) syringes
What are 3 things you would use a larger syringe for?
- IV medications
- add meds to IV solutions
- irrigate drainage tubes
Some syringes require you to change the needle based on 3 considerations
- viscosity of medication
- route of administration
- size of patient
Most insulin syringes are U-____, designed for use with U-_____–_______ insulin
Each mL of solution contains _____ units of insulin
Insulin syringes hold ___ - ___ mL (__ units per __ mL or __units per __mL)
Do insulin syringes come with or without pre attached needles?
U-100; U-100-strength
1 mL=100 units
0.3 mL to 1 mL (30 units per 0.3 mL or 50 units per 0.5 mL)
With preattached needles
What are the three parts of a needle?
All three parts must remain _____ at all times
To prevent contamination, use ___________ with the cap intact
hub: fits onto tip of syringe; shaft: connects to hub; bevel aka slanted tip
STERILE
use gentle force to place the needle onto the syringe with the cap intact
The tip of the needle, or bevel, is always _____
slanted
How does the slanted tip bevel help?
it creates a narrow slit when injected into tissue that quickly closes after the needle is removed to prevent leakage of medication, blood, or serum
True or false: shorter beveled tips are sharper and narrower, which minimizes tissue discomfort during a subQ or IM injection
False! Longer tips are
Most needles vary in length from _____ to ____
3/8 to 3 inches
Use _____ needles ( ___ to ___) for IM injections
Use _____ needles (__ to ___) for SubQ
IM: longer (1 inch - 1 1/2 inch)
SUBQ: shorter (3/8 - 5/8 inch)
Choose the needle length according to which 3 factors:
- patient’s size and weight
- type of tissue to be injected
- route of administration
The (smaller/larger) the needle gauge, the (smaller/larger) the needle diameter
The SMALLER the needle guage, the LARGER the diameter
The guages of needles are ________ for ease of selection
color coded
The selection of a guage depends on what?
The viscosity of fluid to be injected
Match the type of needle you would use to the route of administration
- 25-gauge 5/8-inch needle
- 22-gauge 1 1/2-inch needle
Options:
- IM
- IV
- ID
- SUBQ
- 25-gauge 5/8-inch needle (SUBQ)
- 22-gauge 1 1/2-inch needle (IM)
Prefilled unit-dose systems such as _______ and _____ injection systems use what two items of equipment?
Tubex and Carpuject
reusable plastic syringe holders and disposable, prefilled, sterile, glass cartridge units
Put the following steps in order–using a prefilled system
- stop turning when you hear click
- dispose of glass cartridge in sharps container
- turn plunger rod to the left (counterclockwise)
- follow manufacturers instruction
- advance plunger to expel air and excess med
- remove needle guard
- place cartridge, barrel first, into the plastic syringe holder
- turn plunger rod to the right (clockwise)
a. place cartridge, barrel first, into the plastic syringe holder
b. follow manufacturers instruction
c. turn plunger rod to the left (counterclockwise)
d. turn plunger rod to the right (clockwise)
e. stop turning when you hear click
f. remove needle guard
g. advance plunger to expel air and excess med
h. dispose of glass cartridge in sharps container
Ampules:
- single doses, multiple doses, both
- What form are they available in?
- Available in sizes from ___ to ___ mL
- What must you use when withdrawing medication from ampule
- Should you push air in before taking med out?
- single dose
- liquid form
- size: 1 to 10 mL
- filter needles
- no
Vials:
- What should you do after you open a single-dose vial?
- What should you do after you open a multiple-dose vial?
- What forms do vial contain?
- What are the two most common solutions used with dry medications
- What kind of system is a vial? What does this mean you have to do?
- Do medications need to be drawn up with a filter?
- Why might a prescriber order an injectible med that must be reconstituted?
- discard it
- can be used several times, but only for a single patient; write the date the vial is opened–verify with agency how long an opened vial may be used; discard when time is expired
- liquid or dry
- sterile distilled water and normal saline
- closed-system–you must inject air into vial to permit easy withdrawal
- Some may because of nature of medication–indicated by agency policies and package inserts
- time-sensitive injectable med, must be admin within a specific time period to guarantee full effectiveness
Assess the following 3 patient characteristics before giving a SUBQ or IM injection
- body build
- muscle size
- weight
Why shouldn’t you use an opened alcohol swab to open an ampule? What should you use instead?
Alcohol may leak into ampule; use small gauze pad
When drawing up a med from an ampule; use a filter needle long enough to reach ________
Hold ampule _____ or ______
bottom of ampule to access med
upside down OR set on flat surface
How much air should you inject into a vial?
How should you position the vial when injecting air?
What should you do after?
equivalent to volume of medication to be aspirated from vial
on flat surface
invert after
What should you include on the label of a multi-dose vial?
- date of opening
- concentration of drug per mL
- initials
When drawing up reconstituted medication, should you add air to vial?
NO
When you mix meds from a vial and an ampule, you prepare meds from the (vial/ampule) first.
Then you withdraw medication from the vial/ampule using same/different syringe and a _____ needle
vial first
then from ampule using same syringe and a filter needle
What is insulin classified by?
rate of action, including short duration, intermediate duration and long duration
Which type of insulin should you prepare first if mixing?
short- or rapid-acting
Recommendations for Mixing Insulins
- Patients whose blood glucose is well controlled on a mixed-insulin dose
- No other meds or diluent should be mixed with any insulin product unless ______________
- Do not mix insulin ______________ or __________ with any other types of insulin and do not administer them intravenously
- Administer rapid-acting insulins mixed with NPH insulin within ____ minutes before a meal
- Who should you verify with?
- Patients whose blood glucose is well controlled on a mixed-insulin dose maintain their individual routine when preparing and administering their insulin doses
- No other meds or diluent should be mixed with any insulin product unless approved by the prescriber
- Do not mix insulin glargine (Lantus) or insulin detemir (Levemir) with any other types of insulin and do not administer them intravenously
- Inject rapid-acting insulins mixed with NPH insulin within 15 minutes before a meal
- Who should you verify dosage with during prep?Another nurse
What are the steps to mixing medications from two vials?
- inject air into vial A (do not touch solution)
- Inject air into vial B
- withdraw med from vial B
- Ensure proper volume from vial B
- determine what combined volume should be
- insert needle into vial A
- Invert vial and withdraw medication
- Withdraw and expel excess air
When mixing medications from vials, what should you do if too much medicaiton is withdrawn from second vial?
Discard syringe and start over, do not push medication back into either vial
If________ acting insulin glargine (Lantus) is ordered, note that this is a ______ insulin, and ____________ be mixed with other insulin preparations
glargine (Lantus)
clear
should not
INTRADERMAL INJECTIONS
- What are they used for?
- Why are these medications injected into the dermis?
- for skin testing (TB and allergy tests)
- because they are potent. You inject them into the dermis, where blood supply is reduced and drug absorption occurs slowly. Patient may have anaphylactic reaction if med enters circulation too rapidly
Skin testing often requires you to ______________, therefore make sure that it is __________ and _______________
What are ideal locations for ID injections?
visually inspect the test site; make sure site is free of lesions and injuries and relatively hairless
inner forearm and upper back are ideal locations
ID INJECTIONS
- What size/gauge needle should you use?
- What is the amount you can admin?
- What is the max for children?
- What is the angle of insertion?
- What conclusion can you make if a bleb doesn’t appear or if side bleeds after withdrawal?
- TB or small syringe with a short (3/8 to 5/8-inch), fine-gauge (25-27) needle
- 0.01 to 0.1 mL
- children: 0.1 mL
- 5 to 15 degrees
- medication may have entered subcutaneous tissue–test result won’t be valid
Following an ID injection, what outcomes can you expect:
- What does patient experience?
- What can you see?
- What is patient able to identify?
- patient experiences very mild burning sensation during injection but no discomfort after
- small, light colored bleb 6mm (1/4 inch) in diameter forms at site and gradually disappears. Minimal bruising may be present
- Pt can idetify signs of skin reaction and their significance
What is the size of bleb you would expect following an ID injection?
6 mm (1/4 inch) -light coloured
What are some contraindications your should assess for prior to administering an ID injection?
- reduced local tissue perfusion
- history of serious adverse reactions or necrosis that happened after previous ID injections
Why should an ID injection site be free of discoloration or hair?
So you can see results of skin test and interpret them correctly
When using forearm for ID injection, how should you landmark the best place? Where should you use if you can’t use forearm? If this site isn’t good, what other places would be appropriate?
Select site three to four finger widths below anticubital space and one hand width above wrist
If you can’t, inspect upper back
If necessary, use sites appropriate for SUBQ
What are the steps from start to finish when administering an ID injection?
- Clean site
- Hold swab or gauze between third and fourth fingers of nondominant hand
- remove needle cap from needle by pulling straight off
- hold syringe between thumb and forefinger of dominant hand with bevel of needle pointing up
- Administer injection
- Help pt to comfortable position
- Dispose
- Remove gloves and perform hand hygiene
- Stay with patient for several minutes and observe any allergic reactions
Why do you stay with the patient for several minutes after an ID injection?
To observe for any allergic reaction: dyspnea, wheezing, and circulatory collapse = SEVERE anaphylactic reaction
What are the five steps of administering injection
- with non dominant hand stretch skin over site with forefinger or thumb
- with needle almost against pt skin, insert it slowly at 5 to 15 degree angle until resistance is felt; advance needle through epidermis to approx. 3 mm (1/8 inch) below skin surface. You will se bulge of needle tip through skin
- inject med slowly. Normally you feel resistance. If not, needle is too deep; remove and start again
- When injecting, note that small bleb 6mm[1/4] inch resembling mosquito bite appear on skin
- withdraw needle and apply gauze or alcohol swab gently over site (DO NOT MASSAGE)
What When should you return after injection and what should you do?
Return 15 to 30 minutes
Ask if pt feels any acute pain, burning, numbness, or tingling at injection site (possible tissue damage)
Ask pt to discuss implications of skin testing and signs of allergic rxn (ensures they will report timely if bad rxn)
Inspect bleb–read site at 48-72 hours looking for induration (hard, dense, raised area around injection site
What is induration?
hard, dense, raised area
What kind size of induration is concerning when reading TB test for each of the following:
a. pt with no known risk
b. recent immingrats, injection drug users, residents and employees of high-risk settings, pts with certain chronic illnesses, children less than 4, infants/children/teens exposed to high-risk adults
c. pts with HIV, fibrotic changes of chest x-ray consistent with previous TB infxn, organ transplants, immunosupressed
a. 15mm or more
b. 10mm or more
c. 5 mm or more
Why are subQ injections absorbed more slowly than IM injections
do not contain as many blood vessels
What can influence rate of absorption of subQ drug? Why?
Physical exercise or application of hot or cold compresses
Alter local blood flow to tissue
What kind of condition is a contraindication for subQ injections?
any condition that impairs blood flow
SubQ meds should be given in [small/large] doses [>] __mL
Should be given in small doses less than 2mL
What are 4 necessary characteristics of subQ meds
isotonic, nonirritating, nonviscous, water soluble
Limited research indicates that volumes up to ___mL may be given subQ without tissue damage
2mL
What is the maximum recommended amount of medication to administer subQ at one site in infants and children?
0.5mL
What are 5 examples of subQ medications
epinephrine, insulin, allergy meds, opioids, heparin
Does the patient experience discomfort from a subQ injection? Why?
Yes, they often do experience some because subQ tissue contains pain receptors
What are the 3 best subQ sites and why?
- Outer aspect of the upper arms
- The abdomen from below the costal margins to the iliac crest
- anterior aspects of the thigh
Why? easily accessible and are large enough to allow rotating multiple injections within each anatomic location
For subQ injections, what should you base the needle length and angle of insertion on? Why?
Base the needle length and angle on the pat’s body weight and estimate of subQ tissue. The pts body weight and amount of adipose tissue indicate depth of subQ layer
For subQ injections, you should chose a site that is free of which 3 things?
- skin lesions
- bony prominences
- large underlying muscles or nerves
What is the benefit of site rotation for subQ injections?
Prevents the formation of lipohypertrophy or lipoatrophy in the skin
What two needle sizes/angle/gauge are appropriate for a normal size adult?
What needle size/gauge/angle is appropriate for a child?
25-gauge 3/8-inch @ 45-degrees
25-gauge 1/2-inch @ 90-degrees
Child: 26-30 gauge 1/2 inch at 90-degrees
In terms of site, needle length, and technique, what are special considerations for subQ injections for an obese patient and a thing patient
Obese: pinch tissue and use a needle long enough to insert through fatty tissue at the base of the skinfold
Thin: sometimes have insufficient tissue for injections–therefore the upper abdomen is best site for pts with little peripheral subQ tissue
Should you aspirate after a subQ injection? Why or why not?
No, it isn’t necessary. Piercing a blood vessel and causing hematoma formation are rare
SubQ: Injection pens
What are they?
What are they used to administer?
What are the advantages?
What are the disadvantages?
What is essential? What does this involve?
What are they? pts can self-admin meds subQ; prefilled disposable cartridges
What are they used to administer? (e.g., epi, insulin, interferon)
How are they used? patient pinches skin, inserts needle, and injects predetermined med dose
What are the advantages? convenient
What are the disadvantages? risk for needlestick injury and user’s lack of knowledge and skill in admin technique and how to store device
What is essential? What does this involve? Teaching to ensure correct technique and deliver correct dose of med. Pts need to be taught the importance of purging the pen before a dose is given
SubQ: Needleless injection system
How do they work?
use high-pressure to penetrate the skin with medication into subQ tissue
SubQ: SubQ Injection Device (insuflon)
How does it work?
inserted into subQ tissue; the needle is then removed, leaving the cannula in the tissue to provide an avenue for administering meds for up to 3 days without having to puncture skin with each injection
Why is anatomic injection site rotation for insulin no longer necessary? What process is used instead?
Because newer human insulins carry a lower risk for hypertrophy
Patient’s choose one anatomic area and systematically rotate sites within that region–maintains consistent insulin absorption from day to day
You can leave a subcutaneous injection device in for how many days?
3 days
Absorption rates of insulin vary based on what?
injection site
Where is insulin imost quickly/most slowly absorbed?
Quickly: abdomen
Slowly: thighs
What changes of appearance may indicate a lack of potency when inspecting a vial of insulin?
clumping, frosting, precipitation, change in clarity or color
Where should insulin vials be stored? At what temperature should currently used vials be kept? What temperature should you not inject?
Store in fridge–not freezer
Room temp
Don’t inject cold insulin
What is the preferred injection site for insulin? What should you avoid?
Abdomen–avoiding a 5 cm (2 inch) radius around the umbilicus and outer aspect of thighs
When should you have a patient self-administer insulin?
Whenever possible
Who needs to monitor the blood glucose of patients who take insulin
They do!
When do children generally begin self-administration of insulin?
By adolescence
In the event of a hypoglycemic reaction, what should all patients who take insulin carry around?
at least 15g of carbs (4ox juice, 4oz pop, 8oz skim milk, 6 to 10 hard candies)
What is critical to correct insulin administration?
timing of injections!!
knowing peak action and duration
Health care providers plan insulin injection times based on what?
blood glucose levels and when a patient will eat
What does heparin do, how?
provides therapeutic anticoagulation to reduce the risk of thrombus formation by suppressing clot formation
What are patients receiving heparin at risk for?
- bleeding!!
- gums
- hematemesis
- hematuria
- melena
What allows you to monitor the desired therapeutic range for intravenous heparin therapy
Results from blood coagulation tests
eg. aPTT (activated partial thromboblastin time) and PTT (partial thromboblastin time)
What three areas should you assess before administering heparin? What is included in all of this?
- PREEXISTING CONDITIONS that contraindicate use
- CONDITIONS IN WHICH INCREASED RISK FOR HEMORRHAGE IS PRESENT
- CURRENT MEDICATION REGIMEN (INCL. OTC AND HERBAL)
What are 4 preexisting conditions that contraindicate the use of heparin?
cerebral or aortic aneurysm,
cerebrovascular hemorrhage,
severe htn,
and blood dyscrasia
What are 6 conditions in which increased risk for hemorrhage is present (contraindicate heparin use)
severe diabetes
renal disease
liver disease
severe trauma
recent childbirth
active ulcers or lesions of GI, GU or respiratory tract
What are some herbal medications and regular medications that interact with heparin?
Herbal: garlic, ginger, ginkgo, horse chestnut, feverfew
Reg: aspirin, NSAIDs, cephalosporins, antithyroid agents, probenecid, thrombolytics
Which 2 routes can be used for heparin
subQ and IV
What are the advantages of LMWH?
more effective in some patients
anticoagulant effects more predictable
longer half-life and require less lab monitoring
What is a disadvantage of LMWH
expensive
What is an example of a LMWH?
enoxaparin (Lovenox)
To minimize pain and bruising associated with LMWH, where should it be administered?
What kind of needle should you use and what is one thing you should not do?
right or left side of abdomen, at least 5cm (2inch) away from umbilicus (love handles)
prefilled syringed with the attached needle, do not expel that ir bubble
SubQ: syringe (___-___mL) and needle (___-___guage, __ to ___inch)
SubQ U-100 insulin: insulin syringe (__mL) wiht preattached needle (__to__gauge, ___ to ___inch)
SubQ U-500 insulin: __mL TB syringe with needle (__to__gauge, __to___inch)
- SubQ
- 1 - 3 mL
- 25-27 gauge
- 3/8 to 5/8 inch
- SubQ U-100 insulin
- 1 mL insulin syringe
- 28 - 31 gauge
- 5/16 to 1/2 inch
- SubQ U-500 insulin
- 1 mL TB syringe
- 25-27 gauge
- 1/2 to 5/8 inch
What 3 things should you specifically assess for before admin subQ
- contraindications such as circulatory shock or reduced local tissue perfusion
- adequacy of pt adipose tissue (influences methods for admin injections)
- relevant lab results (blood glucose, partial thromboplastin) - provides baseline
What is the timeframe for giving time-critical meds?
Non-time-critical
Within 30 minutes!!
within 1-2 hours
How many minutes should you apply ice prior to injection to decrease pt perception of pain
1 minute
How can you be sure the needle is the correct size?
grasp skinfold at site with thumb and forefinger-measure fold from top to bottom. Make sure that needle is one-half length of fold
When administering insulin or heparing, use _______ sites first, followed by ______ site
When administering LMWH subQ, choose site ______________. Why?
Why is rotating insulin site within an antomic area good?
abdominal first, then thigh
right or left side of abdomen, 5cm(2inch) away from belly button
maintains consistency in day-to-day absorption
Administer only amounds up to ____ subQ to small children
0.5 mL
What can patients at home use to dispose of sharps?
- own sharps container
- mailing to collection site
- syringe exchange programs
- special devices that destroy needle, rendering it safe for disposal
- hard plastic or metal container (ex empty detergent or coffeecan)
What is the advantage of IM route, risk?
What will affect the rate and extent of drug absorption?
advantage: absorbs faster than subQ
risk: injecting directly into blood vessel
any factor that interferes with local tissue blood flow
IM injection requires a (longer or shorter) and (larger or smaller)-gauge needle
longer and larger
For IM injection, what influences needle size selection?
CDC reccommendations for needle length are based on pt weight and BMI
What influences needle gauge?
viscosity, site, pt weight, amount of adipose tissue
pt weight and BMI
med to be administered
What method is recommended for IM injections? Why?
z-track method
prevents leakage of med into subQ tissues, seals med in muscle, minimizes irritation
Do you need to aspirate after the needle is injected when administering vaccines?
Nope
How to use Z-track method?
pull overlying skin and subQ tissues approx 2.5-3.5 cm (1-1/2 inch) laterally with ulnar side of the nondom hand–inject med and keep inserted for 10 seconds to allow the med to disperse evenly-release skin after withdrawing needle
What factors influence IM injection site selection?
- site that is free of pain, infection, necrosis, bruising, and abrasions
- location of underlying bones, nerves, and blood vessels
- volume of med you will administer
VENTROGLUTEAL SITE:
Which muscles does it involve?
Who is it safe for?
What patient should the patient lie in?
How to landmark?
gluteus medius and minimus
safe for adults and children
have patient lie in either supine or lateral position, to relax muscle lie on back or side, flexing knee and hip
Place heel of hand over the greater trochanter of pt’s hip with wrist perpendicular to femur; right hand for left hip or left hand right hip; point finger toward pt groin; index finger toward ASIS; extent middle finger back along iliac crest toward buttock; injection site in middle of v-shaped triangle
VASTUS LATERALIS
Who is this used for? What is it the preferred site for?
Describe the muscle, including location and size.
What position should patient be in?
How to landmark?
What you should do with young children or cachectic patients?
used in adults and is preferred site for biologics to infants toddlers and children
it is thick and well developed, lovated on anterior lateral aspect of thigh-extends in adult from hand breadth above the knee to hand breadth below greater trochanter. Width usually extends from midline of the thigh to midline of the outer side of the thigh
ask patient to lie flat with the knee slightly flexed and foot EXTERNALLY rotated or assume sitting position
Use middle third of muscle for injection
helps to grasp the body of the muscle to be sure the med is deposited into muscle tissue
DELTOID
What is an advantage?
What is a disadvantage and a big risk?
What volume of meds would you use this site for? What are two other reasons to use this site?
How to landmark?
Position of patient?
easily accessible
muscle is not well developed in many adults
potential for injury because axillary, radial, brachial and ulner nerves and brachial artery lie within upper arm under tris and along humerus
SMALL VOLUME (2mL or less), admin of routine immunizations in toddlers, older children, and adults, other sites inaccessible because of dressings or casts
Patient position: fully expose upper arm and shoulder; ask to relax arm at side or support arm and flex elbow. Do not roll up any tight-fitting sleeve; allow pt to stand, sit, or lie down
Palpate lower edge of acromion process–forms the base of a triangle in line with midpoint of lateral aspect of upper arm–injection site is in center of triangle–3-5cm (1-2 inches) below acromion process. 4 fingers, top one along acromion process–site is three finger widths below
